Provider Demographics
NPI:1659350668
Name:STEWART, ROBERT D (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30 E RIVER PARK PL W
Mailing Address - Street 2:#260
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1545
Mailing Address - Country:US
Mailing Address - Phone:559-441-1777
Mailing Address - Fax:559-441-0726
Practice Address - Street 1:30 E RIVER PARK PL W
Practice Address - Street 2:#260
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1545
Practice Address - Country:US
Practice Address - Phone:559-441-1777
Practice Address - Fax:559-441-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2017-0798208G00000X
CAG33488208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
06334880Medicare ID - Type Unspecified
A45568Medicare UPIN